Poison Control Centres Monica Durigon

Field Epidemiologist Public Health Agency of Canada

Joanne Stares

Public Health Officer Public Health Agency of Canada

Placement site: BC Centre for Disease Control

Environmental Health Services

Environmental Health Surveillance Workshop Ottawa, Ontario

Feb 26, 2013

1

Poison Control Centres Receive calls from the general public and health care

professionals

Manage and respond to poisoning-related inquiries and exposures

Offer interactive service enabling rapid contact, assessment and early intervention

Staffed by health care professionals specially trained in the area of toxicology pharmacists nurses physicians

2

Established use Offer: direct patient care provision of information public and health care

provider education Receive: reports of suspected or

known exposures

3

Classic surveillance cycle

Data collection

Integration

Analysis and Interpretation Dissemination

Action

4

Data collection Basic demographic information

Geographic information caller site exposure site

Substances pharmaceutical and non-pharmaceutical

Exposure calls reason: intentional/unintentional/adverse/unknown routes: dermal/inhalation/ocular/ingestion/parenteral/bite/sting management site: health-care facility/on site

5

Data collection Treatment

Outcomes no effect/minor effect/moderate effect/major effect/death/no follow-up

Information-only calls

6

7

Classic surveillance cycle

Data collection

Integration

Analysis and Interpretation Dissemination

Action

8

Integration – United States National Poison Data System (NPDS)

developed by the American Association of Poison Control Centres (AAPCC)

data repository for all US poison control centres 2009: 61 participating centres services the entire US population anomalies or deviations from established baseline data generate an

automated e-mail alert

Centres can also carry out their own activities independent of the NPDS

9

Integration – Europe France:

10 poison control centres and 3 toxicovigilance centres toxicovigilance network coordinated by the French Institute for Public

Health Surveillance

some poisonings (carbon monoxide and lead) are registered and followed-up at a national level

Germany: 9 poison control centres strong legislation and links to industry

poisonings are reported to a surveillance unit at the Federal Institute for Risk Assessment (Berlin)

10

Classic surveillance cycle

Data collection

Integration

Analysis and Interpretation Dissemination

Action

11

Analysis and interpretation Detect and monitor the emergence of trends and/or novel real-

time incidents in: drug and substance abuse food-borne illness mass poisoning food/medication contamination adverse drug reactions injuries from commercial and consumer products paediatric poisoning

12

Classic surveillance cycle

Data collection

Integration

Analysis and Interpretation Dissemination

Action

13

Dissemination Provide key information to:

regulatory agencies consumer product and safety commissions drug and law enforcement agencies food and drug administration or their counterparts chemical and industry partners public health

14

Classic surveillance cycle

Data collection

Integration

Analysis and Interpretation Dissemination

Action

15

Information for action Implement prevention and control measures

Identify areas for research

Recall consumer products

Influence policy and program planning

16

17

Name Location

Provinces Served

Services Offered

Approximate annual call

volume

Primary data collection tool

Drug and Poison Information Centre

(DPIC) Vancouver, BC

Est. 1975

British Columbia & Yukon

Poison: 24/7 Drug: 9-16

Mon-Fri

36,000 All services

Electronic (since October 2011)

Poison and Drug Information Service

(PADIS) Calgary, AB Est. 1986

Alberta, Saskatchewan & Northwest Territories

Poison: 24/7 Drug: 8-16:15

Mon-Fri Herbal and Medication

Line: 24/7

40,000 All services Paper -based

Ontario Poison Centre Toronto, ON

Est. 1979 Ontario & Manitoba* Poison: 24/7 58,000 Electronic

(since 1997)

Centre Antipoison du Quebec

Quebec City, QC Est. 1986

Quebec Poison: 24/7 45,000 Paper-based

IWK Regional Poison Centre

Halifax, NS Est. 1993

Nova Scotia & Prince Edward Island Poison: 24/7 10,000 Electronic

(since 2006)

*as of July 1, 2012 New Brunswick = 24 hr nurse hotline Newfoundland and Labrador = associated with Janeway Children’s Health and Rehabilitation Centre in St. John’s

Poison Control Centres – Canada, 2013

British Columbia Drug and Poison Information Centre

24/7

Staffed by nurses/pharmacists and supported by medical toxicologists

Located within BCCDC

Oct 2011 – electronic client database

Vancouver

18

Detection of emerging health events – Fukushima

19

0

2

4

6

8

10

12

Mar

ch 1

1,20

11

Mar

ch 1

2,20

11

Mar

ch 1

3,20

11

Mar

ch 1

4,20

11

Mar

ch 1

5,20

11

Mar

ch 1

6,20

11

Mar

ch 1

7,20

11

Mar

ch 1

8,20

11

Mar

ch 1

9,20

11

Mar

ch 2

0,20

11

Mar

ch 2

1,20

11

Mar

ch 2

2,20

11

Mar

ch 2

3,20

11

Mar

ch 2

4,20

11

Mar

ch 2

5,20

11

Mar

ch 2

6,20

11

Mar

ch 2

7,20

11

Mar

ch 2

8,20

11

Mar

ch 2

9,20

11

Mar

ch 3

0,20

11

Mar

ch 3

1,20

11

Calls

Fukushima related calls to both the BC drug line and drug and poison

information line March 11-31, 2011

Drug and Poison Line Drug Line

Monitor trends and identify emerging health events: CO British Columbia

no current measures to monitor or report CO poisonings

Objective evaluate the utility of DPIC electronic client call records for the

surveillance of unintentional, non-fire related CO poisonings in BC

Specifically Data extraction algorithm enabling accurate detection of CO cases System to routinely monitor for CO aberrations

20

Potential to inform policy – Cosmetic pesticides Between 2003 and 2012, 41 municipalities in BC adopted bylaws prohibiting or restricting the use of cosmetic pesticides

20 banned 21 restricted 119 had no bylaws

Can compare historical DPIC data from 2003-2004 with data collected in 2012

Compare occurrence of exposure calls between municipalities where use is prohibited, restricted, or that have no bylaw

Compare occurrence of exposure calls before and after adoption of cosmetic pesticide bylaw

Examine demographic characteristics of individuals exposed

21

Data limitations Self reporting

External validity

Lack of coordination with public health and its partners

Data linkages not easily done

Data coding practices

In Canada, in particular, some centres use paper records

22

Future considerations Joint surveillance network

Highlight the value of the information found in poison control centre databases

Closer links with public health and its partners

Integrate with other data sources

Ensure consistency across centres regarding data coding practices and standards

23

24